| Entity Name: | PREMIER PHARMACY OF JACKSONVILLE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Jun 1997 (28 years ago) |
| Document Number: | P97000051193 |
| FEI/EIN Number | 593451949 |
| Address: | 150 EAST 8TH STREET, JACKSONVILLE, FL, 32206 |
| Mail Address: | 150 EAST 8TH STREET, JACKSONVILLE, FL, 32206 |
| ZIP code: | 32206 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922139021 | 2007-03-08 | 2016-09-14 | 150 E 8TH ST, JACKSONVILLE, FL, 322063704, US | 150 E 8TH ST, JACKSONVILLE, FL, 322063704, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-355-5646 |
| Fax | 9043556263 |
Authorized person
| Name | JOHNNY BATEH |
| Role | PRESIDENT |
| Phone | 9043555646 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH15489 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106170400 |
| State | FL |
| Issuer | PK |
| Number | 2010729 |
| Name | Role | Address |
|---|---|---|
| BATEH JOHNNY M | Agent | 150 EAST 8TH STREET, JACKSONVILLE, FL, 32206 |
| Name | Role | Address |
|---|---|---|
| BATEH JOHNNY M | Director | 150 EAST 8TH STREET, JACKSONVILLE, FL, 32206 |
| BATEH DAVID M | Director | 150 EAST 8TH STREET, JACKSONVILLE, FL, 32206 |
| Bateh Bradley D | Director | 150 EAST 8TH STREET, JACKSONVILLE, FL, 32206 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-02-12 | 150 EAST 8TH STREET, JACKSONVILLE, FL 32206 | No data |
| CHANGE OF MAILING ADDRESS | 2009-02-12 | 150 EAST 8TH STREET, JACKSONVILLE, FL 32206 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-02-12 | 150 EAST 8TH STREET, JACKSONVILLE, FL 32206 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-30 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-02-17 |
| ANNUAL REPORT | 2015-01-29 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2168837304 | 2020-04-29 | 0491 | PPP | 4740 UNIVERSITY BLVD N, JACKSONVILLE, FL, 32277-1000 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Feb 2025
Sources: Florida Department of State
